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Except for a bioterrorism package, Congress is likely to pass no health legislation this year -- despite the fact that major crises are unfolding in health care costs, delivery and quality.

Failure to address longstanding problems -- plus new factors such as the recession and surging insurance costs -- mean that "a 'perfect storm' is about to hit our health care system," warns Henry Simmons, president of the bipartisan National Coalition on Health Care.

A study released last week by the Coalition indicates that health insurance costs are likely to rise by 34 percent between 2000 and 2002, causing 6 million Americans to lose health insurance and raising the number of uninsured to nearly 45 million -- the highest level ever.

And this estimate does not include the likely effects of rising unemployment caused by the recession and the Sept. 11 terrorist attacks -- nor the cuts in Medicaid caused by state budget shortfalls.

The chances are that health care -- while virtually ignored by Washington this year -- could again become the nation's dominant political issue, much as it did between 1990 and 1994.

The failure of the health care reform plan of former First Lady (now Sen.) Hillary Rodham Clinton, D-N.Y., in 1994 essentially scared politicians away from thinking comprehensively about problems that have only festered in the meantime.

Her reform model -- government-run managed care -- is now widely regarded as badly conceived, but no one has developed a new one beyond piecemeal adjustments in the existing system.

And larger partial attacks on the problem -- such as proposals for Medicare reform -- have foundered because of ideological conflict between Republicans and Democrats.

In the meantime, much as warnings about international terrorism were ignored for years, so have reports indicating that the health system is "broken."

A 2000 study by the non-profit Institute of Medicine estimated, for instance, that between 50,000 and 90,000 persons die every year because of medical errors by doctors, hospitals and HMOs.

Instead of concentrating on patient care, institutions in the health system are increasingly focused on their financial bottom line, causing quality to suffer.

In 1997, the federal government cut Medicare payments to providers in order to save money. Strapped hospitals cut care and demanded that nurses work overtime, causing them to leave the profession in droves.
Insurance companies are simultaneously raising premiums, dumping Medicare services, denying benefits and forcing doctors to see more patients in less time.

And doctors, through patients' rights legislation, are trying to inflict their old nemesis -- malpractice lawyers -- upon the insurance industry and HMOs.

There's not only a "perfect storm" raging in health care, but a civil war as well -- and those suffering from it are patients and the uninsured.

Meanwhile, Congress is doing nothing. Medicare reform, including a prescription drug benefit for seniors, is dead. So is patients rights legislation. Aid for the uninsured never got off the ground, frozen out by President Bush's tax cuts.

Bush even backslid on his promise to continue the process of doubling the National Institutes of Health budget over five years, despite campaign rhetoric pronouncing research to be the key to saving dollars as well as lives.

Bush recommended a 13-percent increase instead of the 15 percent required to stay on pace for doubling by 2003 -- a shortfall of $700 million.

Sen. Tom Harkin, D-Iowa, has pushed a 15-percent increase through the Senate, but the House adopted the Bush number. The issue is supposed to be resolved by a House-Senate conference.

Next year, sources say, Bush again may give NIH less than a full boost because it allegedly can't spend what it has -- although it might help if Bush named a new NIH director to give the agency leadership.

The administration reportedly also intends to cut Medicare payments to hospitals once again -- ironically, because the administrator recommending the cuts, Thomas Scully, formerly was head of a hospital lobby that fought to reverse Clinton-era cuts.

Also ironically, Scully's successor as head of the Federation of American Hospitals, Charles "Chip" Kahn, helped write the legislation that imposed the 1997 cuts. Kahn's group is now running ads designed to forestall Scully's new cuts.

Instead of cutting, the Institute of Medicine recommended that the government provide up to $1 billion over five years to help hospitals and doctors acquire up-to-date information systems -- computers and software -- to prevent record-keeping errors.

Famed cyclist Lance Armstrong, in television ads, touts the possibility of every person's carrying his or her medical records on a wallet-sized "smart card," but the country is miles from that.

A private group, the Task Force on Health Care and the Economy, has suggested that investments in such technology could help spur recovery in the hard-hit computer industry.

But the main burden of the National Coalition on Health Care's new "perfect storm" study is that the country needs comprehensive reform of its health delivery system -- starting with an insurance system that covers everyone.

The Coalition is not recommending any particular system -- Canadian, employer-based or private -- but it does recommend that work start on one soon. Smart politicians should get the
message.